Evaluation of a scoring system for assessing prognosis in pediatric acute liver failure.
OBJECTIVE
Pediatric acute liver failure (PALF) results in death or need for liver transplantation (LT) in up to 50% of patients. A scoring system for predicting death or LT (Liver Injury Units [LIU] score) in PALF was previously derived by our group, and used peak values during hospital admission of total bilirubin, prothrombin time/international normalized ratio, and ammonia as significant predictors of outcome. The aims of this study were to test the predictive value of the LIU score in a subsequent validation set of patients and to derive a hospital admission LIU (aLIU) score predictive of outcome.


METHODS
Data were obtained from 53 children admitted with PALF from 2002 to 2006. Outcome was defined at 16 weeks as alive without LT, death, or LT.


RESULTS
Survival without LT at 16 weeks for each LIU score quartile was 92%, 44%, 60%, and 12%, respectively (P < .001). The receiver operating characteristic C index for predicting death or LT by 4 weeks was 86.3. An admission LIU score was derived using admission total bilirubin and prothrombin time/international normalized ratio. Survival without LT at 16 weeks for each quartile using the aLIU score was 85%, 77%, 69%, and 31% (P = .001). The receiver operating characteristic C index for predicting death or LT by 4 weeks was 83.7.


CONCLUSIONS
The original LIU score is a valid predictor of outcome in PALF. The aLIU score is promising and needs to be validated in subsequent patients.
Lu
Brandy R
BR
Department of Pediatrics, The Children's Hospital, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA.
Gralla
Jane
J
Liu
Edwin
E
Dobyns
Emily L
EL
Narkewicz
Michael R
MR
Sokol
Ronald J
RJ
D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002648:Child; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D010372:Pediatrics / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011517:Prothrombin Time; D012372:ROC Curve; D012720:Severity of Illness Index
D000641:Ammonia; D001663:Bilirubin